Red Eye in Dogs and CatS: Conjunctivitis or Worse?

Red Eye in Dogs and CatS:

Conjunctivitis

or Worse?

Tracy Revoir, DVM

Senior Manager of Veterinary Support, Dechra Veterinary Products

It should come as no surprise that conjunctivitis is

the most common ophthalmic disorder in dogs and

cats. But because the clinical signs of conjunctivitis

can mimic those of more serious ophthalmic

diseases (glaucoma and uveitis), it¡¯s important to

confirm your diagnosis.

What are important clues to the severity of the

condition? With conjunctivitis, the inflammation

should be limited to the conjunctiva. Hyperemic

conjunctival vessels are superficial, branching,

and bright red. They are movable over the deeper

episcleral vessels and can be blanched with topical

dilute phenylephrine. With glaucoma and uveitis, the

episcleral vessels are engorged; they are dark red,

deep, straight, and immobile and do not blanch with

topical dilute phenylephrine. With conjunctivitis,

the Schirmer tear test and intraocular pressures

are normal. And the cornea should be clear and no

aqueous flare should be present. The pupil and

pupillary responses are normal and intraocular

structures should be visible.

In suspected cases of conjunctivitis (or any

ophthalmic condition), a careful diagnostic workup

should be performed. Initial diagnostic testing

should include a Schirmer tear test, corneal

fluorescein staining, intraocular pressure

measurement, eyelid examination, and conjunctival

cytology or culture.

Common Causes of Conjunctivitis

If you do confirm conjunctivitis, the next step is

identifying the cause. If both eyes are affected and

abnormal clinical signs are apparent in other body

systems, think underlying systemic disease. If only

one eye is affected, rule out infection, tear film

deficiencies, an irritant, anatomical abnormality,

or deeper ocular disease.

In dogs, conjunctivitis can result from anatomical

disorders, irritants, infection (usually bacterial), or

atopy. Most bacterial infections are secondary

conditions, most often to allergies. In cats, herpesvirus and Chlamydophila felis are the most common

causes of conjunctivitis. Atopy can also be

an issue in cats.

Addressing the Problem

Treating canine conjunctivitis is generally more

straightforward than feline conjunctivitis. Clean the

eye first and then apply topical ophthalmic drugs.

Topical ointments can offer several advantages over

solutions, including longer drug contact time with

surface tissues, lack of tear dilution, smaller amount

of drug entering the nasolacrimal system (and

potentially less systemic effects), and protection of

the cornea due to their petroleum vehicle.

Because many cases of conjunctivitis are allergic in

nature, they respond well to topical steroid

administration. And even if a mild infection is

present, most dogs will benefit from topical steroids.

Apply them three to four times daily for five to seven

days. Triple antibiotic ointment with hydrocortisone

(Vetropolycin? HC [bacitracin-neomycin-polmyxin1% hydrocortisone acetate] Veterinary Ophthalmic

Ointment) is one option.

With cases of acute bacterial conjunctivitis in dogs,

topical antibiotic administration may speed

resolution. Apply an antibacterial ointment three to

four times daily for five to seven days. Broadspectrum antibiotics such as triple-antibiotic

preparations should be used as the first line of

treatment if the infection is mild to moderate and

the infectious agent is unknown. Broad-spectrum

agents include triple antibiotic ointment

(Vetropolycin? [bacitracin-neomycin-polmyxin] Veterinary Ophthalmic Ointment) and tetracycline.

Bacitracin is effective against gram-positive

bacteria, polymyxin B is effective against gramnegative bacteria, and neomycin is effective against

both types of bacteria. These antibiotics are also

good choices because they are rarely used

systemically. With chronic bacterial conjunctivitis,

investigate why the condition is chronic and treat

with antibacterials based on conjunctival culture and

sensitivity results.

To treat a cat with acute infectious conjunctivitis,

topical tetracycline ointment is a good first choice.

This product is effective against C. felis and

secondary bacterial pathogens. In cats with

conjunctivitis, topical glucocorticoids are generally

avoided because most cases of conjunctivitis are

infectious in nature. If there is no response to

symptomatic treatment or if systemic disease signs

are present, then perform a more complete

diagnostic workup and consider referral to a

veterinary ophthalmologist.

Take-home points

When a dog or cat presents with a red eye, it¡¯s

critical to determine whether the problem is

conjunctivitis or a more serious disease. If it is

conjunctivitis, treatment is generally straightforward,

especially in dogs. Treatment success relies on

addressing the underlying cause.

VETROPOLYCIN?

VETROPOLYCIN? HC

bacitracin-neomycin-polymyxin

veterinary ophthalmic ointment

bacitracin-neomycin-polymyxinhydrocortisone acetate 1%

veterinary ophthalmic ointment

STERILE - ANTIBACTERIAL

NADA # 065-016. Approved by FDA.

DESCRIPTION: Each gram contains Bacitracin Zinc 400 units,

Neomycin Sulfate 5 mg (equivalent to 3.5 mg of Neomycin base),

Polymyxin B Sulfate 10,000 units, in a base of White Petrolatum

and Mineral Oil.

ACTIONS: The three antibiotics present in Vetropolycin?

(bacitracin-neomycin-polymyxin) veterinary ophthalmic ointment

provide a broad spectrum of activity against the gram-postitive

and gram-negative bacteria commonly involved in superficial

infections of the eyelid and conjunctiva. Bacitracin is effective

against gram-postitive bacteria including hemolytic and nonhemolytic streptococci and staphylococi. Resistant strains rarely

develop. Neomycin is effective against both gram-positive and

gram-negative bacteria including staphylococci, Escherichia coli

and Haemophilus influenzae and may strains of Proteus and

Pseudomonas. Polymyxin B is bactericidal to gram-negative

bacteria especially Pseudomonas. No resistant strains have been

found to develop in vivo.

STERILE - ANTIBACTERIAL

NADA # 065-015. Approved by FDA.

DESCRIPTION: Each gram contains Bacitracin Zinc 400 units, Neomycin Sulfate

5 mg (equivalent to 3.5 mg of Neomycin base), Polymyxin B Sulfate 10,000 units,

Hydrocortisone Acetate 10 mg (1%), in a base of White Petrolatum and Mineral Oil.

ACTIONS: The overlapping spectra of these three antibiotics provide effective

bactericidal action against most commonly occurring gram-positive and gramnegative bacteria associated with infections of the eyes. The range of bactericidal

activity encompasses many bacteria which are, or have become, resistant to other

antibiotics, notably Pseudomonas and Staphylococcus. In susceptible organisms,

resistance rarely develops, even on repeated or prolonged usage. Hydrocortisone

acetate exerts a marked anti-inflammatory action at the tissue level and effectively

suppresses inflammation in many disorders of the anterior segment of the eye. Local

application to the eye often gives rapid relief of pain and photophobia, particularly

in lesions of the cornea. The combined anti-inflammatory and antimicrobial activity

of Vetropolycin? HC (bacitracin-neomycin-polymyxin-hydrocortisone acetate 1%)

veterinary ophthalmic ointment permits effective management of many disorders of

the anterior segment of the eye in which combined activity is needed.

INDICATIONS: It may be used in acute or chronic conjunctivitis, when caused by

organisms susceptible to the antibiotics contained in this ointment. Laboratory tests

should be conducted including in vitro culturing and susceptibility tests on samples

collected prior to treatment.

INDICATIONS: In the treatment of superficial bacterial

infections of the eyelid and conjunctiva in dogs and cats when

due to organisms susceptible to the antibiotics contained in the

ointment. Laboratory tests should be conducted including in vitro

culturing and susceptibility tests on samples collected prior to

treatment.

CONTRAINDICATIONS: Ophthalmic preparations containing corticosteroids are

contraindicated in the treatment of those deep, ulcerative lesions of the cornea where

the inner layer (endothelium) is involved, in fungal infections and in the presence of

viral infections.

PRECAUTIONS: Sensitivity to Vetropolycin? (bacitracinneomycin-polymyxin) veterinary ophthalmic ointment is rare;

however, if a reaction occurs, discontinue use of the preparation.

As with any antibiotic preparation, prolonged use may result in the

overgrowth of non-susceptible organisms including fungi.

Appropriate measures should be taken if this occurs. If infection

does not respond to treatment in two or three days, the diagnosis

and therapy should be re-evaluated.

Clinical and experimental data have demonstrated that corticosteroids administered

orally or by injection to animals may induce the first stage of parturition if used during

the last trimester of pregnancy and may precipitate premature parturition followed by

dystocia, fetal death, retained placenta, and metritis.

Care should be taken not to contaminate the applicator tip of the

tube during application of the preparation. Do not allow the

applicator tip to come in contact with any tissue.

ADVERSE REACTIONS: Itching, burning or inflammation may

occur in animals sensitive to the product. Discontinue use in such

cases.

DOSAGE AND ADMINISTRATION: Apply a thin film over the cornea three or four times daily in dogs and cats. The area should be

properly cleansed prior to the use of Vetropolycin? (bacitracinneomycin-polymyxin) veterinary ophthalmic ointment. Foreign

bodies, crusted exudates, and debris should be carefully removed.

CAUTION: Federal law restrict this drug to use by or on the order

of a licensed veterinarian.

WARNINGS: All topical ophthalmic preparations containing corticosteroids with or

without an antimicrobial agent, are contraindicated in the initial treatment of corneal

ulcers. They should not be used until the infection is under control and corneal

regeneration is well under way.

Additionally, corticosteroids administered to dogs during pregnancy have also

resulted in other congenital anomalies, including deformed forelegs, phocomelia, and

anasarca.

PRECAUTIONS: Sensitivity to the ophthalmic ointment is rare, however, if a reaction

occurs, discontinue use of the preparation. The prolonged use of antibioticcontaining preparations may result in overgrowth of non-susceptible organisms

including fungi. Appropriate measures should be taken if this occurs. If infection does

not respond to treatment in two or three days, the diagnosis and therapy should be

reevaluated. Animals under treatment with this product should be observed for usual

signs of corticosteroid overdose which include polydipsia, polyuria and occasionally

an increase in weight. Use of corticosteroids, depending on dose, duration, and

specific steroid, may result in inhibition of endogenous steroid production following

drug withdrawal. In patients presently receiving or recently withdrawn from systemic

corticosteroid treatments, therapy with a rapidly acting corticosteroid should be

considered in unusually stressful situations. Care should be taken not to contaminate

the applicator tip during administration of the preparation.

ADVERSE REACTIONS: Itching, burning or inflammation may occur in animals

sensitive to the product. Discontinue use in such cases. SAP and SGPT (ALT) enzyme

elevations, polydypsia and polyuria have occurred following parenteral or systemic

use of synthetic corticosteroids in dogs. Vomiting and diarrhea (occasionally bloody)

have been observed in dogs.

Cushings syndrome in dogs has been reported in association with prolonged or

repeated steroid therapy.

WARNING: Do not use this product as a pre-surgical ocular

lubricant. Adverse reactions of ocular irritation and corneal

ulceration have been reported in association with such use.

DOSAGE AND ADMINISTRATION: Apply a thin film over the cornea three or four

times daily. The area to be treated should be properly cleansed prior to use. Foreign

bodies, crusted exudates and debris should be carefully removed. Insert the tip of

the tube beneath the lower lid and express a small quantity of the ointment into the

conjunctival sac in dogs and

cats.

HOW SUPPLIED: 3.5 g (1/8 Oz) sterile tamper proof tubes.

CAUTION: Federal law restricts this drug to use by

or on the order of a licensed veterinarian.

NDC 17033-028-38.

HOW SUPPLIED: 3.5 g (1/8 Oz) sterile tamper proof

tubes.

NDC 17033-030-38.

STORE AT 15?-25?C (59?-77?F).

STORE AT 15?-25?C (59?-77?F).

Manufactured for:

Dechra veterinary Products

Overland Park, KS 66211.

TAKE TIME

Ini0912

R1112

OBSERVE LABEL

DIRECTIONS

Manufactured for:

Dechra veterinary Products

Overland Park, KS 66211.

Ini0912

R1112

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